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Health Law Insights - Peer Review / Credentialing

The New York Supreme Court, Appellate Division, held on January 13 that the Health Care Quality Improvement Act (HCQIA) precluded an aggrieved physician from maintaining a defamation action concerning statements made during a peer review meeting. Defendant Mercy Medical Center (MMC) received numerous complaints from other physicians and staff regarding the plaintiff physician’s behavior, including allegations that the plaintiff raised his voice in the ICU, made rude and inappropriate remarks in front of patients, intimidated nurses, and made improper entries in patient charts. Consistent with MMC’s medical staff bylaws, the medical director and staff chair requested that the medical staff executive committee take corrective action against the plaintiff, and referred the matter to the credentials committee. The medical director and other witnesses testified about the plaintiff’s improper behavior during a subsequent meeting of the credentials committee. The committee unanimously recommended that the plaintiff’s clinical privileges and medical staff membership be suspended. The medical executive committee later recommended the termination of the plaintiff’s privileges, as authorized under the bylaws. The plaintiff failed to request a hearing to review that recommendation but instead instituted a defamation lawsuit against MMC, the medical director, and the staff chair. The Appellate Division held in Colantonio v. Mercy Med. Ctr. that although the statements made during the credentials committee meeting weren’t absolutely privileged under the federal HCQIA insofar as the meeting was not quasi-judicial in nature, the statements were still protected from disclosure under HCQIA’s qualified privilege. HCQIA’s qualified privilege permits disclosure when a plaintiff produces evidence that the statements made by the witnesses were false and that the witnesses had knowledge that their statements were false. Because the plaintiff failed to meet this burden, the documents were shielded from production.

Privileges for Documentation Referenced by Peer Review Committees Not Absolute, According to West Virginia Court

In a ruling that has potential implications for state peer review privilege statutes across the country, West Virginia’s highest court held on February 9 that a document is not shielded from disclosure solely by nature of its utilization by a peer review committee. Rather, a document must be created solely or exclusively by or solely for the use of the committee to trigger the protection of West Virginia’s peer review privilege. The court in State ex rel Wheeling Hosp., Inc. v. Wilson observed that “merely because a review organization uses, in its deliberative process, records kept by a medical facility in the ordinary course of business does not mean that all such facility records are then sequestered from the grasp of discovery . . . .” Though the documents in the case at hand were protected from discovery by a medical malpractice plaintiff because they were created for the review committee, the court found that documents originating from other sources may be discoverable if requested from the original source.

A federal court in Vermont held on January 25 that the state’s peer review statute shielded from discovery documents relating to review by The Joint Commission (TJC) of a patient’s suicide at a mental health facility. The plaintiff moved to compel production of records between the facility, TJC, and an HMO in a wrongful death action against the facility. The Vermont peer review statute identifies four kinds of entities that qualify as peer review committees privy to the law’s protection, including a committee of a hospital or other health care provider. The law provides that the “proceedings, reports, and records” of such peer review committees are “confidential and privileged.” The court acknowledged that TJC did not technically fall within any of the protected categories under the law but nevertheless held that the materials were shielded by the statute. The court noted that other Vermont courts had previously found that TJC constitutes a “peer review committee” under the statute, focusing on the type of work it does, which is “clearly peer review in nature.” The court also rejected the plaintiff’s argument that the documents were discoverable because they were not created during a formal review process, but rather reflected “conversations and documents arising in the course of ordinary business operations.” The court found that the documents were consistent with the formal peer review processes contemplated by the statute and that they were very different from a mere “conversation between staff about ‘quality control,’” which, presumably, would not be protected. The court also held that none of the records were “original source” documents merely reviewed by TJC.

Compare jurisdictions: Arbitration

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